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Obese? What Your Doc May Be Overlooking

January 13, 2011

By Amanda Gardner

WEDNESDAY, January 12 (Health.com) — Ann Silk, MD, worries about her overweight patients. But Dr. Silk, an internal-medicine resident at the University of Pittsburgh Medical Center, isn’t concerned only about their diets and cholesterol levels. She also worries that the fatty tissue on their bodies will obscure other health problems, like tumors.

Although excess weight is hard on a patient’s body, it’s also hard on doctors who are trying to perform physical exams. Blood pressure cuffs have to be bigger. Stethoscopes can’t pick up subtle heart abnormalities and lung sounds muffled by flesh. And medical scales often max out at 350 pounds—making it hard to determine exactly how overweight the largest patients are.

Moreover, excess body fat can interfere with a doctor’s ability to assess thyroid or liver health or recognize abnormal growths. Even with all the high-tech medical tools at their disposal, doctors still find out some important, potentially life-saving information by touching and feeling their patients’ bodies. Fat makes that job much tougher.

“It’s a worry that we’re not finding what we need to find on exams because there is tissue in the way of our fingers, and in the way of our stethoscope,” says Dr. Silk, who co-authored an article about this problem in this week’s issue of the Journal of the American Medical Association. “It leaves us with a little bit of uncertainty—maybe you would even say insecurity—whether we are identifying all the abnormalities on [an] exam.”

In some cases, this uncertainty could lead to missed tumors or other oversights, Dr. Silk adds. “For the abdominal and gynecological exam, a mass would have to be pretty big before you could find it.”

John Simmons, MD, an assistant professor of family and community medicine at the Texas A&M Health Science Center, in College Station, says that doctors can’t identify conditions such as liver problems, hernias, and fluid buildup in the abdomen through physical exams alone. Still, he says, abdominal, breast, thyroid, and genital examinations are particularly difficult in obese patients.

For this reason, obese patients should be especially proactive about making sure they get regular screening tests, Dr. Simmons says. If necessary, they should “take it upon [themselves] to remind the doctor of potentially embarrassing but critically important screening tests like mammograms, Pap smears, genital exams, and colonoscopies.”